747 Review of practices around perinatal sentinel events of preterm babies with severe neurological injury in a single tertiary care centre in Canada
Bibliographic record
Abstract
Background Preterm infants born <33 weeks gestational age (GA) are at risk of intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) in the early peri-natal period. Grades 3 and 4 IVH and PVL are considered severe neurological injury (SNI) and the prevalence of neurodevelopmental disability in survivors is high. Objectives This project aims to analyze practices and trends over a 10 years span, around major sentinel events, which are known to have contributory role in causality of SNI in preterm babies, in a single tertiary care, level 3 NICU with a higher rate of SNI compared to the national annual rates according to the Canadian Neonatal Network (CNN). Methods The nation-wide Evidence Based Practice for Improving Quality (EPIQ) Guidelines have an enlisted set of sentinel events with levels of recommendations spanning multiple disciplines, to reduce the SNI in this population. We assessed practices around each antenatal, intrapartum and early postnatal sentinel event. A total of 42 sentinel events were analyzed in a retrospective cohort of babies who were born <33 weeks and went on to have SNI. These babies were born between January 1, 2010 to December 31, 2019. Antenatal events reviewed were steroids, presence of chorioamnionitis or abruption; intrapartum events like MgSO4, mode of delivery, fetal bradycardia. Postnatal events looked into were resuscitation, intubation, pain and temperature management, hemodynamic and ventilation strategies and hematological parameters like platelet count and sodium levels, till 72 hours of life. Babies with major congenital anomalies, antenatally diagnosed brain injury, and infants transferred after 72 hours of life were excluded. Results Of the cohort of 134 babies that met inclusion criteria, 31.1% are outborn and 50% are ≤26 weeks. The median SNAP II score was 21. Through the 10 years, outborn babies were consistently seen to have significantly low incidence of antenatal steroids (p 0.001) and MgSO4 (p 0.001) and were more likely to become hypothermic (p 0.017) or need multiple intubation attempts at delivery (p 0.009). The ≤26 weeks cohort who went on to incur a SNI, were significantly more likely to be hypernatremic (p 0.001), hypercarbic (p 0.010) with acidosis (p 0.013) requiring bi-carbonate infusion (p 0.002) and inotropic support (p 0.015). The rates of delayed cord clamping (DCC) could not be commented on as the documentation was variable with different definition of ‘delayed’ being used throughout the province. Conclusions This study sheds light on practices carried out in a particularly populated province in Canada and highlights potential areas requiring focus so as to improve rates of SNI in this unit. It also aims to address areas to improve documentation like DCC in the CNN database. Timely maternal transfer to tertiary care and enhancing perinatal care in referral centers, specifically increasing use of MgSO4 and reducing hypothermia, remain a priority in this province. Among infants <26 weeks higher rates of hypernatremia and hypercapnia were identified as somewhat modifiable risk factors associated with SNI. Considering half the cohort was >26 weeks, it is crucial to improve adoption of evidence-based neuroprotective strategies for all infants <33 weeks GA.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.021 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.008 | 0.021 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".